Müge BOZKURT, Cüneyt EVREN, Gökhan UMUT, Ruken AGACHANLİ, Bilge EVREN

Alkol kullanım bozukluğu olan ve yatarak tedavi gören hastalarda aşermenin şiddeti erişkin DEHB belirtilerinin şiddeti ile ilişkilidir

Amaç: Bu çalışmanın amacı alkol kullanım bozukluğu olan ve yatarak tedavi gören hastalarda aşerme şiddetinin erişkin dikkat eksikliği hiperaktivite bozukluğu (DEHB) belirti şiddeti ile ilişkisini anksiyete ve depresyonun etkisini de kontrol ederek incelemektir. Yöntem: Çalışmaya alkol kullanım bozukluğu nedeniyle yatarak tedavi gören 78 hasta alındı. Katılımcılar arındırma döneminin ardından, son alkol alımlarının üzrinden 3-4 hafta geçtikten sonra, Obsesif-Kompulsif İçme Ölçeği (OKİÖ), Erişkin Dikkat Eksikliği Hiperaktivite Bozukluğu Kendi Bildirim Ölçeği (ASRS-v1.1), Durumluk ve Sürekli Kaygı Envanteri (STAI) ve Beck Depresyon Ölçeği (BDÖ) ile değerlendirilmiştir. Sonuçlar: Sürekli kaygı, OKİÖ puanlarını belirlemiş olsa da lineer regresyon analizinde ASRS-18 puanı hesaplamaya katıldığında aşermenin şiddetini sadece ASRS-18 puanı belirlemiştir. ASRS-6 için de sonuçlar aynı bulunmuştur. ASRS-18'in alt ölçeklerinde aşermeyi dikkat eksikliği puanları belirlemiştir. Aşermenin obsesif ve kompulsif boyutları bağımlı değişken olarak ele alındığında ise ASRS-18/ASRS-6 sürekli kaygı ile birlikte obsebif aşermeyi belirlerken, kompulsif aşermeyi sadece ASRS-18/ASRS-6 belirlemiştir. Sonuç: Bu sonuçlar DEHB belirti şiddetinin (özellikle dikkat eksikliği belirtilerinin) aşerme şiddeti ile ilşkili olduğunu göstermektedir. DEHB belirtileri kompulsif aşerme şiddetinini tek başına belirlemiş olsa da, obsesif aşerme şiddetini sürekli kaygı ile birlikte belirlemiştir. ASRS-18 ve ASRS-6 ile benzer sonuçlar elde edilmiş olması, daha az madde içeren ASRS6'nın bu popülasyonda DEHB belirtilerini taramak için kullanılabileceğini düşündürmektedir.

Severity of craving is related with severity of adult ADHD symptoms among inpatients with alcohol use disorder

Objective: The aim of the present study was to evaluate relationship of craving severity with severity of adult attention-deficit/hyperactivity disorder (ADHD) symptoms in a sample of inpatients with alcohol use disorder, while controlling the effects of anxiety and depressive symptoms. Methods: Participants included 78 inpatients with alcohol use disorder. Participants were evaluated with the Obsessive-Compulsive Drinking Scale (OCDS), the Adult ADHD Self-Report Scale (ASRS-v1.1), the State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI) after a detoxification period of three to four weeks. Results: Although trait anxiety predicted OCDS score, trait anxiety was no longer a predictor after entering ASRS-18 score and the ASRS-18 score was the only predictor for severity of craving in linear regression analyses. Results for the ASRS-6 were the same. Among subscales of ASRS-18 inattentive score predicted OCDS score. When obsessive and compulsive dimensions of craving were taken as dependent variables, ASRS-18/ASRS-6 predicted obsessive craving score together with the trait anxiety, whereas ASRS-18/ASRS-6 predicted compulsive craving alone. Conclusion: These findings suggest that severity of ADHD symptoms (particularly inattentive symptoms) is related with severity of the craving. Although ADHD symptoms predicted compulsive craving alone, it predicted obsessive craving together with the trait anxiety. Also ASRS-18 and ASRS-6 showed similar results, suggesting that ASRS-6 with much less items can be used among this population for screening ADHD symptoms.

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1. Janca A, Ustün TB, Early TS, Sartorius N. The ICD-10 symptom checklist: a companion to the ICD-10 classification of mental and behavioural disorders. Soc Psychiatry Psychiatr Epidemiol 1993; 28:239-242.
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5TM). Arlington, VA: American Psychiatric Association, 2013.
3. Bottlender M, Soyka M. Impact of craving on alcohol relapse during, and 12 months following, outpatient treatment. Alcohol Alcohol 2004; 39:357-361.
4. Miller WR, Westerberg VS, Harris RJ, Tonigan JS. What predicts relapse? Prospective testing of antecedent models. Addiction 1996; 91(Suppl.):155-172.
5. Monti PM, Abrams DB, Binkoff JA, Zwick WR, Liepman MR, Nirenberg TD, et al. Communication skills training, communication skills training with family and cognitive behavioral mood management training for alcoholics. J Stud Alcohol 1990; 51:263-270.
6. Cooney NL, Litt MD, Morse PA, Bauer LO, Gaupp L. Alcohol cue reactivity, negative-mood reactivity, and relapse in treated alcoholic men. J Abnorm Psychol 1997; 106:243-250.
7. O'Connor PG, Gottlieb LD, Kraus ML, Segal SR, Horwitz RI. Social and clinical features as predictors of outcome in outpatient alcohol withdrawal. J Gen Intern Med 1991; 6:312-316.
8. Evren C, Durkaya M, Dalbudak E, Celik S, Cakmak D. Factors related with relapse in male alcohol dependents: 12 months follow-up study. J Psychiatry neurobilogical Sci 2010; 23:92-99.
9. Evren C, Cetin R, Durkaya M, Dalbudak E, Cakmak D. Relationship of alcohol craving with posttraumatic stress disorder and severity of general psychopathology in male alcohol dependent inpatients. Archives of Neuropsychiatry 2009; 46:3-7. (in Turkish)
10. Fox HC, Bergquist KL, Hong K-I, Sinha R. Stress-induced and alcohol cue-induced craving in recently abstinent alcohol-dependent individuals. Alcohol Clin Exp Res 2007; 31:395-403.
11. Sinha R, Fox HC, Hong KA, Bergquist K, Bhagwagar Z, Siedlarz KM. Enhanced negative emotion and alcohol craving, and altered physiological responses following stress and cue exposure in alcohol dependent individuals. Neuropsychopharmacology 2009; 34:1198-1208.
12. Klein RG, Mannuzza S, Olazagasti MAR, Roizen E, Hutchison JA, Lashua EC, et al. Clinical and functional outcome of childhood attention-deficit/ hyperactivity disorder 33 years later. Arch Gen Psychiatry 2012; 69:1295-1303.
13. Johann M, Bobbe G, Putzhammer A, Wodarz N. Comorbidity of alcohol dependence with attention-deficit hyperactivity disorder: differences in phenotype with increased severity of the substance disorder, but not in genotype (Serotonin Transporter and 5-Hydroxytryptamine-2c Receptor). Alcohol Clin Exp Res 2003; 27:1527-1534.
14. Roncero C, Ortega L, Pérez-Pazos J, Lligoña A, Abad AC, Gual A, et al. Psychiatric comorbidity in treatment-seeking alcohol dependence patients with and without ADHD. J Atten Disord 2015; pii: 1087054715598841.
15. Szobot CM, Roman T, Hutz MH, Genro JP, Shih MC, Hoexter MQ, et al. Molecular imaging genetics of methylphenidate response in ADHD and substance use comorbidity. Synapse 2011; 65:154-159.
16. Wilens TE, Martelon M, Fried R, Petty C, Bateman C, Biederman J. Do executive function deficits predict later substance use disorders among adolescents and young adults? J Am Acad Child Adolesc Psychiatry 2011; 50:141-149.
17. Brady KT, Sinha R. Co-occurring mental and substance use disorders: the neurobiological effects of chronic stress. Am J Psychiatry 2005; 162:1483-1493.
18. Estévez N, Dey M, Eich-Höchli D, Foster S, Gmel G, Mohler-Kuo M. Adult attention-deficit/ hyperactivity disorder and its association with substance use and substance use disorders in young men. Epidemiol Psychiatr Sci 2015; 20:1- 12.
19. Wilens TE, Biederman J, Mick E, Faraone S V, Spencer T. Attention deficit hyperactivity disorder (ADHD) is associated with early onset substance use disorders. J Nerv Ment Dis 1997; 185:475- 482.
20. Wilens TE, Fusillo S. When ADHD and substance use disorders intersect: relationship and treatment implications. Curr Psychiatry Rep 2007; 9:408-414.
21. Wilens TE, Biederman J, Mick E. Does ADHD affect the course of substance abuse? Findings from a sample of adults with and without ADHD. Am J Addict 1998; 7:156-163.
22. Young JT, Carruthers S, Kaye S, Allsop S, Gilsenan J, Degenhardt L, et al. Comorbid attention deficit hyperactivity disorder and substance use disorder complexity and chronicity in treatment-seeking adults. Drug Alcohol Rev 2015; 34:683-693.
23. Wilens TE, Martelon M, Joshi G, Bateman C, Fried R, Petty C, et al. Does ADHD predict substance-use disorders? A 10-year follow-up study of young adults with ADHD. J Am Acad Child Adolesc Psychiatry 2011; 50:543-553.
24. Seitz A, Wapp M, Burren Y, Stutz S, Schläfli K, Moggi F. Association between craving and attention deficit/hyperactivity disorder symptoms among patients with alcohol use disorders. Am J Addict 2013; 22:292-296.
25. Bidwell LC, Henry EA, Willcutt EG, Kinnear MK, Ito TA. Childhood and current ADHD symptom dimensions are associated with more severe cannabis outcomes in college students. Drug Alcohol Depend 2014; 135:88-94.
26. Evren C, Cetin R, Dalbudak E, Durkaya M, Cakmak D, Flannery B. Relationship of Cloninger's personality dimensions with alcohol craving in male alcohol dependent inpatients. Bulletin of Clinical Psychopharmacology 2009; 19:373-381.
27. Evren C, Durkaya M, Cetin R, Dalbudak E, Cakmak D, Flannery B. Relationship of alcohol craving with alexithymia and dissociation in male alcohol dependent inpatients. Anadolu Psikiyatri Derg 2009; 10:165-173. (Turkish)
28. Anton RF, Moak DH, Latham P. The Obsessive Compulsive Drinking Scale: a self-rated instrument for the quantification of thoughts about alcohol and drinking behavior. Alcohol Clin Exp Res 1995; 19:92-99.
29. Anton RF, Moak DH, Latham PK. The obsessive compulsive drinking scale: A new method of assessing outcome in alcoholism treatment studies. Arch Gen Psychiatry 1996; 53:225-231.
30. Moak DH, Anton RF, Latham PK. Further validation of the Obsessive-Compulsive Drinking Scale (OCDS). Relationship to alcoholism severity. Am J Addict 1998; 7:14-23.
31. Evren C, Celik S, Evren B, Aksoy R. Validation study of the Turkish version of the obsessive compulsive drinking scale in male alcohol dependent inpatients. Dusunen Adam: The Journal of Psychiatry and Neurological Sciences 2011; 24:1-12.
32. Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med 2005; 35:245-256.
33. Kessler RC, Adler LA, Gruber MJ, Sarawate CA, Spencer T, Van Brunt DL. Validity of the World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener in a representative sample of health plan members. Int J Methods Psychiatr Res 2007; 16:52-65.
34. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62:617-627.
35. Dogan S, Oncu B, Saracoglu G, Kucukgoncu S. Validity and reliability of the Turkish version of the Adult ADHD Self-Report Scale (ASRS-v1.1). Anadolu Psikiyatri Derg 2009; 10:77-87. (inTurkish)
36. Evren C, Umut G, Teksin-Unal G, Agachanli R, Evren B. Psychometric properties of the Turkish version of the Adult ADHD Self-Report Scale (ASRS) in a sample of inpatients with alcohol use disorder. Dusunen Adam J Psychiatry Neurol Sci 2016; 29: (Article in press).
37. Spielberger C, Gorsuch R, Lushene R. Manual for the State-Trait Anxiety Inventor, Palo Alto (Calif): Consulting Psychologist Press, 1970.
38. Oner N, Le Compte A. Durumluk Sürekli Kaygı Envanteri El Kitabı, İstanbul: Boğaziçi Üniversitesi Yayınları,1985.
39. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4:561-571.
40. Hisli N. Reliability and validity of Beck Depression Inventory among university students. Turkish Journal of Psychology 1989; 7:3-13. (Turkish)
41. Frodl T. Comorbidity of ADHD and Substance Use Disorder (SUD): a neuroimaging perspective. J Atten Disord 2010; 14:109-120.
42. Evren C, Durkaya M, Evren B, Dalbudak E, Cetin R. Relationship of relapse with impulsivity, novelty seeking and craving in male alcohol-dependent inpatients. Drug Alcohol Rev 2012; 31:81- 90.
43. Berlin I, Hu M-C, Covey LS, Winhusen T. Attention-deficit/hyperactivity disorder (ADHD) symptoms, craving to smoke, and tobacco withdrawal symptoms in adult smokers with ADHD. Drug Alcohol Depend 2012; 124:268-273.
44. Barkley R, Murphy K, Fischer M. ADHD in Adults: What the Science Says. New York: Guilford Press, 2008.
45. Willcutt EG. The prevalence of DSM-IV attentiondeficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics 2012; 9:490-499.
46. Chhabildas N, Pennington BF, Willcutt EG. A comparison of the neuropsychological profiles of the DSM-IV subtypes of ADHD. J Abnorm Child Psychol 2001; 29:529-540.
47. Giancola P, Moss H. Executive cognitive functioning in alcohol use disorders. M Galanter (Ed.), Recent Developments in Alcoholism: Vol. 14. The Consequences of Alcoholism, New York: Plenum Press, 1998, p. 227-251.
48. Pihl RO, Peterson JB, Finn P. An heuristic model for the inherited predisposition to alcoholism. Psychol Addict Behav 1990; 4:12-25.
49. Lukasiewicz M, Benyamina A, Reynaud M, Falissard B. An in vivo study of the relationship between craving and reaction time during alcohol detoxification using the ecological momentary assessment. Alcohol Clin Exp Res 2005; 29:2135-2143.
50. Yoon G, Kim SW, Thuras P, Grant JE, Westermeyer J. Alcohol craving in outpatients with alcohol dependence: rate and clinical correlates. J Stud Alcohol 2006; 67:770-777.
51. Glöckner-Rist A, Lémenager T, Mann K. Reward and relief craving tendencies in patients with alcohol use disorders: results from the PREDICT study. Addict Behav 2013; 38:1532-1540.
52. Bujarski S, Ray LA. Negative affect is associated with alcohol, but not cigarette use in heavy drinking smokers. Addict Behav 2014; 39:1723- 1729.
53. Pehlivanidis A, Papanikolaou K, Spyropoulou AC, Papadimitriou GN. Comorbid attention-deficit/hyperactivity disorder in adult psychiatric outpatients with depressive or anxiety disorders. Int J Psychiatry Clin Pract 2014; 18:265-271.
54. Das D, Cherbuin N, Butterworth P, Anstey KJ, Easteal S. A population-based study of attention deficit/hyperactivity disorder symptoms and associated impairment in middle-aged adults. PLoS One 2012; 7:e31500.
55. Barkley R. Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis. New York: The Gulliford Press, 2006.
56. Hyman SE. The diagnosis of mental disorders: the problem of reification. Annu Rev Clin Psychol 2010; 6:155-179.